Michelangelo Buonocore

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1 L ELETTROMIOGRAFIA NEL DOLORE NEUROPATICO Michelangelo Buonocore Fondazione Maugeri Istituto Scientifico di Pavia Servizio di Neurofisiopatologia Laboratorio di Biopsia Cutanea Neurodiagnostica

2 DEFINIZIONE DI ELETTROMIOGRAFIA Electromyography (EMG) is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons). A nerve conduction study, another part of an EMG, uses electrodes taped to the skin (surface electrodes) to measure the speed and strength of signals traveling between two or more points.

3 DEFINIZIONE DI ELETTROMIOGRAFIA Electromyography (EMG) Strictly defined, the recording and study of insertion, spontaneous, and voluntary activity of muscle with a recording electrode (either a needle electrode for invasive EMG or a surface electrode for kinesiologic studies). The term is also commonly used to refer to an electrodiagnostic medicine consultation, but its use in this context is discouraged.

4 DEFINIZIONE DI ELETTRONEUROGRAFIA Electroneurography (ENG) The recording and study of the action potentials of peripheral nerve. Synonymous with nerve conduction studies.

5 DEFINIZIONE DI ELETTRONEUROMIOGRAFIA Electroneuromyography (ENMG) The combined studies of electromyography and electroneurography. Synonymous with clinical electromyography. See preferred term electrodiagnostic medicine consultation.

6 DEFINIZIONE DI DOLORE NEUROPATICO NEUROPATHIC PAIN Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system Treede et al. 2008

7 SISTEMA SOMATO-SENSORIALE Cruccu et al. 2008

8 DOLORE NEUROPATICO NO RECETTORI ATTIVATI Pain usually arises as a consequence of activation of primary nociceptive afferents by actually or potentially tissue-damaging stimuli and processing of this activity within the nociceptive system. This type of pain is physiologic. Pain, however, may also arise by activity generated within the nociceptive system (?) without adequate stimulation of its peripheral sensory endings. For these clinical conditions, the term neuropathic pain has been introduced. Treede et al 2008

9 GENESI ECTOPICA DI IMPULSI Buonocore 2007

10 DOLORI NOCICETTIVO E NEUROPATICO Buonocore

11 NO STRUMENTI DIAGNOSTICI SPECIFICI PER NP Because of the lack of a specific diagnostic tool for neuropathic pain, a grading system of definite, probable, and possible neuropathic pain is proposed Treede et al. Neurology 2008

12 NP E INDAGINI STRUMENTALI Treede et al 2008

13 it is essential to demonstrate in the individual patient that this disorder does affect the somatosensory system (evidence for neural damage). Treede et al. Neurology 2008

14 The neurologic diagnosis depends on the answers to two questions: Where is the lesion? (anatomy) What type of lesion? (pathology, including pathophysiology) These principles also apply to neuropathic pain Treede et al. Neurology 2008

15 L Elettromiografia (EMG + ENG) studia solo fibre di grande calibro, siano esse motorie o sensitive (sistema lemniscale). non studia le piccole fibre del sistema nocicettivo/spino-talamico

16 EMG E DOLORE NEUROPATICO L EMG propriamente detto può essere utile per la diagnosi di dolore neuropatico dimostrando la presenza di: Lesioni radicolari Lesioni di nervi misti Lesioni di nervi motori

17 SISTEMA LEMNISCALE ED ENG SENSITIVA ElettroNeuroGrafia (ENG) nucleusinc.com

18 SISTEMA LEMNISCALE E PESS Potenziali Evocati Somato-Sensitivi (PESS) Spehlmann 1985

19 It needs to be stressed that patients with somatosensory deficits do not necessarily have pain Treede et al. Neurology 2008

20 DIAGNOSI STRUMENTALE Nessuna diagnosi algologica andrebbe mai fatta sulla base di un risultato anormale ottenuto nel corso di una valutazione strumentale Dick et al. 1998

21 NEUROFISIOLOGIA NEUROIMMAGINI CLINICA DIAGNOSI ALGOLOGICA NEUROPATOLOGIA (ES. BIOPSIA CUTANEA) PSICOFISIOLOGIA (ES. QST)

22 Percorso diagnostico INTERVISTA DEL PAZIENTE ESAME OBIETTIVO IPOTESI DI MECCANISMO FISIOPATOLOGICO IMPOSTAZIONE DELLA TERAPIA CONFERMA STRUMENTALE Buonocore e Bonezzi

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